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Vancouver woman returns from India, dies with super-resistant infections

A 76-year-old woman returned from a three-month stay in India earlier this year and was found to be infected with bacteria carrying NDM-1 -- a gene that confers resistance to practically all antibiotics. She died soon thereafter.

Her case is discussed in a new article in the journal Emerging Infectious Diseases. The authors are doctors at Vancouver General Hospital and in the Public Health Agency of Canada. They describe the circumstances of the woman’s case:

A 76-year-old woman returned to Vancouver, Canada, in early 2010 after spending 3.5 months in northern India. Before her trip, she had been in good health. In India, persistent nonbloody diarrhea developed, for which she did not seek medical attention. One month later, she was treated in the hospital for hypertension and congestive heart failure. She was discharged 3 days after admission but readmitted 3 days later because of ongoing diarrhea and decreased consciousness.

Unspecified encephalitis and a urinary tract infection were diagnosed, but despite antibacterial drug therapy, her neurologic status did not improve over the next 3 weeks. She was discharged from the hospital in India and transferred to Canada.

When she arrived at the hospital in Vancouver on February 14, 2010, her vital signs reflected distributive shock: temperature 38.3°C, blood pressure 100/80 mm Hg, and heart rate 126 beats/minute. Sepsis was suspected and she was given imipenem and vancomycin. Within 24 hours, her level of consciousness had deteriorated, and she was admitted to the intensive care unit and intubated for airway protection.

Blood cultures were negative, but urine culture (>1 × 108 CFU/mL) grew highly drug-resistant K. pneumoniae N10–0469 (February 15, 2010) with intermediate resistance to chloramphenicol and susceptibility to colistin. The urine was packed with leukocytes, and no other source for sepsis was found. A perirectal sample, screened for resistant gram-negative rods, grew K. pneumoniae N10–0506 and E. coli N10–0505 (February 16, 2010). A stool specimen was negative for ova and parasites but positive for Clostridium difficile toxin.

The woman was transferred from intensive care to a general ward, where she died a few days later. Tests showed that the bacteria she carried were highly resistant. The doctors conclude that the arrival in North America of NDM-1 “is of concern” because it is not only resistant but spreads rapidly.

US science writer Maryn McKenna, discussing the report on her blog Superbug, writes:

The bacteria possessing the resistance gene are not only Klebsiella, which people have come to expect, but also E. coli, a bug that, unlike Klebsiella, is not usually confined to hospitals, but exists freely in the outside world and in all of us. The implication, though no one can say for sure, is that the outside world — what public health calls “the community” — is where this woman picked up her infection.

Crawford Kilian is a contributing editor of The Tyee.

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